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Chapter 112. Venous Thrombosis (Part 6)

Tham khảo tài liệu 'chapter 112. venous thrombosis (part 6)', y tế - sức khoẻ, y học thường thức phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | Chapter 112. Venous Thrombosis Part 6 Table 111-3 Long-Term Treatment with Vitamin K Antagonists for Deep Vein Thrombosis DVT and Pulmonary Embolism PE Patient Categories Duration months Comments First episode of DVT or PE secondary to a transient reversible risk factor 3 Recommendation applies to both proximal and calf vein thrombosis First episode of idiopathic DVT or PE 6-12 Continuation of anticoagulant therapy after 6-12 months may be considered First episode of DVT 6-12 Continuation of or PE with a documented thrombophilic abnormality anticoagulant therapy after 6-12 months may be considered First episode of DVT or PE with documented antiphospholipid or two or more thrombophilic abnormalities 12 Continuation of anticoagulant therapy after 12 months may be considered The preferred intensity of VKA treatment for DVT is an INR between 2 and 3. Higher intensities are not more effective whereas lower intensities are less effective with a similar bleeding risk. Although VKAs are generally used for longterm treatment LMWH is preferred in patients with DVT and concomitant cancer. This treatment is associated with a lower risk of recurrent thrombosis than VKA and a similar risk of bleeding. The role of thrombolytic therapy as well as surgical removal of the thrombus in the initial treatment of DVT is controversial the current recommendations are to refrain from their use with the single exception of patients with massive recent ileofemoral DVT at risk of limb gangrene. Patients with DVT are at risk of developing the postthrombotic syndrome in the first years after the initial episode. This syndrome can range from mild with some swelling and pain at the end of the day to severe with massive swelling and skin ulceration. Graduated elastic compression stockings to the knee with an ankle pressure of 30-40 mmHg fitted in the first weeks after the initial thrombosis and worn for 2 years reduce the risk of the postthrombotic syndrome by 50 . As a result of the introduction .